Endoscopic Doppler US probe for the diagnosis of gastric varices (with videos)

BackgroundGastric varices may appear similar to enlarged gastric folds and submucosal neoplasms at endoscopy. A simple endoscopic method to diagnose variceal blood flow without formal EUS could be clinically useful.ObjectiveTo demonstrate the use of Doppler US (DOP-US) in the diagnosis of gastric varices.DesignCase series.SettingA tertiary-care U.S. academic medical center.PatientsEight patients with findings of gastric submucosal lesions of uncertain etiology on EGD.InterventionsEGD with DOP-US examination, with or without standard EUS.Main Outcome MeasurementsPresence or absence of audible DOP-US signal and EUS findings for gastric submucosal lesions.ResultsDOP-US demonstrated a reproducible continuous venous hum in 5 cases of gastric varices (confirmed by EUS in 2 cases). A sixth case of gastric varices demonstrated pulsatile flow with DOP-US (confirmed by EUS). In 1 case of a GI stromal tumor (GIST) in the stomach, no signal was heard when the lesion itself was examined by DOP-US. In a final case of Menetrier's disease, no signal was heard when the giant gastric folds were examined.ConclusionsDOP-US can help differentiate gastric varices from other gastric submucosal lesions. The use of DOP-US may obviate the need for EUS to confirm gastric varices when the EGD diagnosis is uncertain.